How 3D printing enabled the world’s first middle ear transplant

Professor Mashudu Tshifularo spent 10 years of his life in search of a solution for conductive hearing loss. He finally developed one, inspired by new technologies of the Fourth Industrial Revolution

Prof Mashudu Tshifularo, a former herdsman who later became the first black Ear, Nose and Throat (ENT) specialist,  discovered a way to perform a successful ear surgery to cure hearing loss.

In South Africa, it’s estimated that between four and six in every 1 000 South African children will be born with, or will develop, hearing-loss in their first weeks of life. The South African Hearing Institute has in the past warned that  hearing ability naturally declines from the age of 30 or 40 – and that by age 80, more than half of South Africans will suffer from some form of significant hearing loss. Hearing loss can also occur as a result of trauma, disease or infection, and may be inherited.

Efforts to solve this challenge have been plagued by challenges. Conductive hearing loss is a case in point. It  occurs when the ossicles – the bones of the inner ear, and the smallest in the human body – become damaged.  Conductive hearing loss can however be treated through surgical reconstruction using prostheses made from stainless steel struts and ceramic cups. The challenge however is that this surgery, which generally involves tailoring a prosthesis for each patient in the operating room, is plagued by high failure rates.

This global and South African challenge has moved, Prof Mashudu Tshifularo, a former herdsman who later became the first black Ear, Nose and Throat (ENT) specialist,  to spend 10 years of his life in search of a solution.

Prof Tshifularo was  born in poverty in Thohoyandou to a large family. During his youth he tended his family’s livestock and attended school under a tree. After completing his grade 12 in 1982, Tshifularo studied pre-medicine at the University of Venda and then went on to study further at the University of KwaZulu-Natal.

He later became one of the youngest medical professional to be appointed to Medunsa’s Department of Otorhinolaryngology. He has published in peer-reviewed journals and travelled extensively lecturing about, among others, HIV manifestations in the field of Otorhinolaryngology, rhinology, otology and cochlear implants. Professor Tshifularo spent 10 years investigating how to find the right prosthesis for an ear surgery. New technologies that are associated with the 4th Industrial Revolution gave him an idea.

In the last few years he has been looking into the use of 3D technologies to scan and rebuild damaged areas of the ear that include some of the smallest bones in the body. His research found that 3D technology was the best solution.

In 2019, at Steve Biko Academic Hospital he performed what is now regarded as the world’s first transplant of middle-ear bones using 3D printed components. This new procedure offers hope for those suffering from one particular type of hearing impairment: conductive hearing loss, a middle-ear problem caused by congenital birth defects, infection, trauma or metabolic diseases.

This surgery involved a partial or singular prosthetic replacement or implant of the affected bones. The surgery has already been used to treat two patients.  Tshifularo transplanted 3D printed ear bones into a second patient with an underdeveloped middle ear, replacing the hammer, anvil and stirrup. The process essentially rebuilt the patient’s middle ear ossicles with the help of titanium 3D printing. Professor Tshifularo holds a number of patents for middle ear implants and has published extensively in a number of leading peer-reviewed journals. He has dedicated himself to the training of students from disadvantaged groups and has been instrumental in training more black ENT specialists from other institutions in South Africa.

In addition to treating conductive hearing loss, the 3D printed ear bones could be used to simplify other aural procedures, including ossiculoplasty and stapedectomy, because they lessen the risk of intrusion trauma. The breakthrough surgery and idea also reduces the risk of facial nerve paralysis, which can happen during ear surgery if a facial nerve that passes through the middle ear is damaged.

He is passionate about innovation, he believes the world should invest in medical innovation for a healthier future. Although he is currently working on his second PhD, Prof Tshifularo would like to build an Otorhinolaryngology hospital focusing only on hearing research and rehabilitation – treatments for cochlear implants, middle ear implants, brain stem implants and bone-anchored hearing aids. To achieve this objective, Prof Tshifularo would like to get funding to make it a reality. He is also interested in training more young doctors and nurses. He would also like to get young scientists to be involved in 4IR innovations related to health.

Prof Tshifularo foresees that in future it will be possible for people to print their own health with proper approvals from authorities. He believes that 3D will have a significant impact in the health industry, especially for personal health.

He points out that 3D is already making a difference in various health areas. He highlights how 3D printing has been instrumental in the development of protective gear during the Covid-19 pandemic. He points out that the 3D  printing of masks is a classic example of health solutions that will be brought about by 3D technologies.

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